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Investigation of Anterior Open Bite Malocclusion by Means of Dental Arch Measurements, Cephalometrics and Cinefluorography of Deglutition

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Investigation of Anterior Open Bite Malocclusion by Means of Dental Arch Measurements, Cephalometrics and Cinefluorography of Deglutition Loyola University Chicago Loyola eCommons Master's Theses Theses and Dissertations 1968 Investigation of Anterior Open Bite Malocclusion by Means of Dental Arch Measurements, Cephalometrics and Cinefluorography of Deglutition Charles Henry Fink Loyola University Chicago Follow this and additional works at: https://ecommons.luc.edu/luc_theses Part of the Dentistry Commons Recommended Citation Fink, Charles Henry, "Investigation of Anterior Open Bite Malocclusion by Means of Dental Arch Measurements, Cephalometrics and Cinefluorography of Deglutition" (1968). Master's Theses. 2265. https://ecommons.luc.edu/luc_theses/2265 This Thesis is brought to you for free and open access by the Theses and Dissertations at Loyola eCommons. It has been accepted for inclusion in Master's Theses by an authorized administrator of Loyola eCommons. For more information, please contact [email protected]. This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License. Copyright © 1968 Charles Henry Fink / INVESTIGATION OF ANTERIOR OPEN BITE MALOCCLUSION BY MEANS OF DENTAL ARCH MEASUREMENTS, CEPHALOMETRICS AND CINEFLUOROGRAPHY OF DEGLUTITION BY CHARLES H. FINK A THESIS SUBMITTED TO THE FACULTY OF THE GRADUATE SCHOOL OF LOYOLA ijNIVERSITY IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE JUNE 1968 ,I.., \, , AUTOBIOGRAPHY Charles Henry Fink was born in Madison, Wisconsin on April 19, 1939. He graduated from Franklin High School in Franklin, Louisiana in May, 1957. He attended Louisiana State University for three years, began his dental studies at Loyola University in New Orleans and graduated in June, 1964. He served as a Dental Officer in the United States Navy from June 1964 until June 1966 while stationed in Charleston, South Carolina. In June, 1966 he began his studies of Oral Biology and Orthodontics at Loyola University of Chicago. ii ACKNOWLEDGEMENTS I wish to extend my sincere appreciation to my co~advisor, Dr. Douglas C. Bowman, Professor of Physiology, for his conscientious effort and display of interest in the composition and experimental method of this thesis. I wish to thank my co-advisor, Dr. Donald C. Hilgers, Chairman, Department of Orthodontics, for his help in obtaining the cinefluorograph and the materials used in this study. I wish to thank the members of my thesis advisory board, Drs. Bowman, Hilgers and Kiely for their helpful suggestions and refinement regarding this thesis. I will always be deeply indebted to Dr. Joseph R. Jarabak, my teacher, and the Loyola-Jarabak Foundation, for their fore­ sight and the deep scientific interest necessary to install and finance the cinefluorograph in the Orthodontic Department of Loyola University Dental School. I am very grateful to my parents for their encouragement and financial support throughout the duration of my schooling. I am most grateful to my wife, Carole, for her loyalty, hard work, and the sacrifices she made for four years. With her support and devotion, I was able to continue my education. iii TABLE OF CONTENTS Chapter Page I. INTRODUCTION AND STATEMENT OF THE PROBLEM ..... 1 II. REVIEW OF THE LITERATURE ...................... 4 A. Cinefluorography - History and Technique B. Methods of Quantitative Cinefluorography C. Studies of Swallowing Patterns D. The Hyoid Bone - Anatomy and Physiology E. Open Bite - Studies and Etiology F. Cephalometrics of the Cranial Base, Hyoid Position and Movement III. METHODS AND MATERIALS ......................... 38 A. Introduction B. Radiation Output C. Radiation Dosage to the Operator D. Open Bite Population and Normal Sample E. Medical and Dental History F. Dental Casts G. Photographs H. Cepha10grams I. Cinefluorographic Film Sequences J. Cranial Landmarks and Method of Analyzing Hyoid Movement IV. FINDINGS ..................................•... 64 A. Medical and Dental History B. Dental Casts C. Photographs D. Cepha10metrics E. Hyoid Motion Analysis F. Observation of the Swallowing Pattern V. DISCUSSION .........................•.......... 81 VI. SUMMARY AND CONCLUS IONS ...................... 94 APPENDIX ................................................ 97 BIBLIOGRAPHY ............................................ 99 iv LIST OF ILLUSTRATIONS / Figure Page 1. The Cinefluorograph •••...•.•.••••.•.•••..... 40 2 • The Profile Shield ...••.••.•.......•••••..•• 41 3. Bjork Analysis ............................. 48 4. The Optical Cephalostat .••.•.•••....••.•.•.• 52 5. Analytical Projector and Projection Cabinet • 56 6. The H 1 Angle · .............................. 59 7. The H 2 Angle · .............................. 60 8. The H 3 Angle · .............................. 61 9. The Occlusal Plane H Angle .•••..•.•...••...• 63 10. Normal Swallowing Pattern •..•.•••••••••••..• 73 11. Hyoid Patterns ............................. 77 12. Bird's Head Silhouettes ...•••........•.•••.. 79 v LIST OF TABLES Table Page 1. Cast Measurements of Functional Open Bites Compared to Values From Pont .•........... 66 2 • Cast Measurements of Skeletal Open Bites Compared to Values From Pont •...•........ 67 3. "t" Comparisons Between Group II and III Cast Measurements. .......•.........•..•.. 68 4 • Angular and Linear Values of Bjork Analysis in Group II and III and Their "t" Comparisons ............................. 70 5. Angular Values of Hyoid Motion in Group I, II and III and Their "t" Comparisons .. 71 vi CHAPTER I INTRODUCTORY REMARKS AND STATEMENT OF THE PROBLEM The literature is filled with statements as to the etiology of the anterior open bite malocclusion. Anterior open bite has been defined as "an open vertical dimension between the incisal edges of the maxillary and mandibular anterior teeth. While this situation exists, some of the buccal teeth are in definite occlusal contact." Various habits, diseases, and aberrant growth patterns are some of the conditions that have been suggested as re­ sponsible for the development and maintenance of the anterior open bite malocclusion. Some of these.suggestions have been based upon sound observation and scientific reasoning; others have not. It is evident that no single factor is the sole cause of the problem. There is more than one type of anterior open bite malocclusion from the standpoint of etiology. Many authors have described these malocclusions as associated with habits such as non-nutritive sucking and tongue thrusting. Others have mentioned skeletal growth patterns as responsible for the malocclusion. Some have discussed the problem from the standpoint of treatment. 1 2 An attempt must be made to classify the open bite mal­ occlusion as to factors of its etiology and maintenance. Many attempts have been made in the treatment of the malocclusion; some have been successful, and others have not. Many cli· nicians will never attempt its treatment. It is a malocclusion of great renown as to its difficulty of treatment and retention. It is no wonder that investigators know so little of its cause and effect relationship. Until recently, there have been no real specialized diagnostic tools that could probe into the internal meshanism of the animal body. Early investi­ gators could only speculate etiology from observations of stone models or dry skulls. Cephalograms came later, but even then there were no recognized norms of skeletal morphology, growth and development. The necessary number of sophisticated diagnostic instruments have been unavailable for the segregation and obser­ vation of synchronous movement and pressure eqtiilibrium associ­ ated with various functions of the animal body. Only in the last fifteen years has an instrument, the cinefluorograph, been developed that could show internal movements of the animal body, record these movements permanently, and still not expose the body to undue amounts of radiation or damage during a specified period of time. Although cinefluorographic technique is far 3 from being of a precision quality, it does, however, provide a means of exploring internal motion. Clinical treatment, to be successful, of necessity, demands an accurate diagnosis_and understanding of the etiology and mechanism of the malocclusion. According to de Coster (1936) only 16.7% of the treated open bites can be considered to demonstrate clinically excellent results. Open bites can almost always be closed, yet successful results are determined only by successful retention. Relapse denotes treatment failure and this sometimes is not evident for many years. The purpose of this investigation is to study the anterior open bite malocclusion from the standpoint of etiology so as to relate form and function in the establishment of treatment objectives. Through the use of lateral cephalograms, the open bite cases will be divided into two groups: skeletal and functional. Movement of the hyoid bone during swallowing will be examined primarily with respect to the mandible and cranial base. Movement of the tongue will also be observed with respect to the hard palate, and the anterior teeth. CHAPTER II REVIEW OF THE LITERATURE A. Cinef1uorcgraphy - History and Technique Cinematography describes the production of the illusion of motion with the aid of the motion picture. Indirect and direct roentgen cinematography are the two basic methods of making motion pictures with x-rays. These two methods were investigated by Macintyre in 1897. The direct method of roentgen cinematography consists of making multiple, sequential exposures on x-ray film with or without the aid of radiographic intensifying screens. Rapid serial radiography is an example
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